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Nehme M, Schrempft S, Baysson H, Pullen N, Rouzinov S, Stringhini S, Guessous I. Associations Between Healthy Behaviors and Persistently Favorable Self-Rated Health in a Longitudinal Population-Based Study in Switzerland. J Gen Intern Med 2024; 39:1828-1838. [PMID: 38528233 PMCID: PMC11282021 DOI: 10.1007/s11606-024-08739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Self-rated health is a subjective yet valuable indicator of overall health status, influenced by various factors including physical, psychological, and socio-economic elements. Self-rated health could be telling and used by primary care physicians to evaluate overall present and predictive health. DESIGN This study investigates the longitudinal evolution of self-rated health in Switzerland during the COVID-19 pandemic, focusing on the association of persistently favorable self-rated health with various predictors. PARTICIPANTS This study based on the Specchio cohort, a population-based digital study in Geneva Switzerland, involved participants completing questionnaires from 2021 to 2023. MAIN MEASURES Self-rated health was assessed alongside factors like physical and mental health, socio-economic status, and lifestyle behaviors. KEY RESULTS The study included 7006 participants in 2021, and 3888 participants who answered all three follow-ups (2021, 2022, and 2023). At baseline, 34.9% of individuals reported very good, 54.6% reported good, 9.6% reported average, and 1.0% reported poor to very poor self-rated health. Overall, 29.1% had a worsening in their self-rated health between 2021 and 2023. A subset of participants (12.1%) maintained very good self-rated health throughout, demonstrating persistently favorable self-rated health during the COVID-19 pandemic. Positive health behaviors were associated with persistently favorable self-rated health (exercise aOR 1.13 [1.03-1.24]; healthy diet aOR 2.14 [1.70-2.68]; less screen time aOR 1.28 [1.03-1.58]; and better sleep quality aOR 2.48 [2.02-3.04]). Mental health and social support also played significant roles. CONCLUSION The study underscores the significance of healthy lifestyle choices and social support in maintaining favorable self-rated health, particularly during challenging times like the COVID-19 pandemic. Primary care physicians should focus on promoting these factors, integrating these actions in their routine consultations, and advising patients to undertake in socially engaging activities to improve overall health perceptions and outcomes.
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Affiliation(s)
- Mayssam Nehme
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Stephanie Schrempft
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Helene Baysson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nick Pullen
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Serguei Rouzinov
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
- School of Population and Public Health and Edwin S.H, Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Lodin K, Espinosa-Ortega F, Dastmalchi M, Vencovsky J, Andersson H, Chinoy H, Lilleker JB, Shinjo SK, Maurer B, Griger Z, Ceribelli A, Torres-Ruiz J, Mercado M VD, Leonard D, Alexanderson H, Lundberg IE. Patient global assessment and inflammatory markers in patients with idiopathic inflammatory myopathies - A longitudinal study. Semin Arthritis Rheum 2024; 65:152379. [PMID: 38241913 DOI: 10.1016/j.semarthrit.2024.152379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Abstract
AIM To explore if patient global assessment (PGA) is associated with inflammation over time and if associations are explained by other measures of disease activity and function in patients with idiopathic inflammatory myopathies (IIM). METHODS PGA and systemic inflammatory markers prospectively collected over five years were retrieved from the International MyoNet registry for 1200 patients with IIM. Associations between PGA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and creatine kinase (CK) were analyzed using mixed models. Mediation analysis was used to test if the association between PGA and inflammatory markers during the first year of observation could be explained by measures of disease activity and function. RESULTS PGA improved, and inflammatory markers decreased during the first year of observation. In the mixed models, high levels of inflammatory markers were associated with worse PGA in both men and women across time points during five years of observation. In men, but not in women, the association between elevated ESR, CRP and poorer PGA was explained by measures of function and disease activity. With a few exceptions, the association between improved PGA and reduced inflammatory markers was partially mediated by improvements in all measures of function and disease activity. CONCLUSION Increased levels of systemic inflammation are associated with poorer PGA in patients with IIM. In addition to known benefits of lowered inflammation, these findings emphasize the need to reduce systemic inflammation to improve subjective health in patients with IIM. Furthermore, the results demonstrate the importance of incorporating PGA as an outcome measure in clinical practice and clinical trials.
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Affiliation(s)
- Karin Lodin
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
| | - Fabricio Espinosa-Ortega
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Maryam Dastmalchi
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, United Kingdom; Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Britta Maurer
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Zoltan Griger
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Jiram Torres-Ruiz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Vazquez-Del Mercado M
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Instituto de Investigación en Reumatología y del Sistema Músculo Esquelético (IIRSME), Guadalajara, Mexico
| | - Dag Leonard
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Helene Alexanderson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna, Stockholm, Sweden; Women's Health and Health Professional Theme, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E Lundberg
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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Ivarsson B, Johansson A, Kjellström B. Change in health-related quality of life at early follow-up in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pulm Circ 2024; 14:e12349. [PMID: 38420145 PMCID: PMC10899573 DOI: 10.1002/pul2.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
Symptoms associated with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) impact patient's health-related quality of life (HRQoL). Studies on change and if a minimal clinically important difference (MCID) in HRQoL is reached within a year after diagnosis are lacking. The aim was to investigate the change in HRQoL as well as the proportion of patients that reached MCID at an early postdiagnosis visit. The study included adult patients from the Swedish PAH & CTEPH registry, diagnosed 2008-2021, with Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) at time of diagnosis and a follow-up. Data were analyzed as total population and dichotomized for sex, age (<65 vs. ≥65 years), time of diagnosis (≤2015 vs. >2015) and pulmonary hypertension (PH) subgroups. Data reported as median, interquartile range (IQR), and proportions (%). There were 151 patients (PAH = 119, CTEPH = 32) with an available CAMPHOR score at diagnosis and follow-up. CAMPHOR total sum was 31 (IQR: 21-43) and 25 (14-36); (p < 0.001) at diagnosis and follow-up, respectively. At follow-up, 56% had reached MCID in total sum, while for domains activity, symptoms, and QoL 27%, 33%, and 39% reached MCID, respectively. These results were independent of PH subgroup, diagnosis before or after 2015 and sex. Age below 65 years was related to improvements in activity and worsening of symptoms. In conclusion on a group level, improvements in CAMPHOR total sum as well as all domains were seen in the first year after diagnosis, however, only slightly more than half of the patients reached MCID for CAMPHOR total sum.
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Affiliation(s)
| | | | - Barbro Kjellström
- Department of MedicineKarolinska InstituteStockholmSweden
- Department of Clinical Physiology, Clinical SciencesLund University and Skåne University HospitalLundSweden
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Kang W. Diabetes Moderates the Link between Personality Traits and Self-Rated Health (SRH). Healthcare (Basel) 2023; 11:2149. [PMID: 37570389 PMCID: PMC10418877 DOI: 10.3390/healthcare11152149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/15/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES The primary objective of this study is to explore the relationship between personality traits and self-rated health (SRH) in individuals with diabetes, while also comparing these associations with a group of healthy controls. METHODS The data for this study were obtained from the UK Household Longitudinal Study (UKHLS), comprising a sample of 1860 diabetes patients and 12,915 healthy controls who were matched in terms of age and sex. Hierarchical linear regression was utilized to analyze the data. The analysis included demographic variables such as age, sex, monthly income, highest educational qualification, marital status, and psychological distress assessed through the GHQ-12, personality traits, including Neuroticism, Agreeableness, Openness, Conscientiousness, and Extraversion, and diabetes status (0 for diabetes patients, 1 for healthy controls) as predictors. Interactions between personality traits and diabetes status were also included as predictors, with SRH serving as the dependent variable. Additionally, separate multiple regression analyses were conducted for diabetes patients and healthy controls, incorporating demographic variables, psychological distress, and personality traits as predictors, while SRH remained the dependent variable. RESULTS The findings of this study indicate that diabetes significantly moderates the association between Neuroticism and SRH. Specifically, both Neuroticism and Extraversion were negatively associated with SRH, whereas Openness and Conscientiousness exhibited a positive association with SRH in healthy controls. However, among diabetes patients, only Conscientiousness showed a positive association with SRH. CONCLUSION Personality traits predict SRH in people with and without diabetes differently. Healthcare professionals and clinicians should try to come up with ways that improve SRH and thus better outcomes in diabetes patients based on the findings from the current study.
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Affiliation(s)
- Weixi Kang
- Department of Brain Sciences, Imperial College London, London W12 0BZ, UK
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Kang W, Malvaso A. Personality Traits Predict Self-Rated Health (SRH) in Coronary Heart Disease (CHD) Patients and Healthy Controls. Healthcare (Basel) 2023; 11:healthcare11111645. [PMID: 37297784 DOI: 10.3390/healthcare11111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The objective of the present study is to examine the association between Big Five personality traits and self-rated health (SRH) among individuals with coronary heart disease (CHD), and to compare this relationship with that of healthy control participants, which is of importance as SRH can be a determinant of outcomes. METHODS The current study used data from 566 participants with CHD with a mean age of 63.00 (S.D. = 15.23) years old (61.13% males) and 8608 age- and sex-matched healthy controls with a mean age of 63.87 (S.D.= 9.60) years old (61.93% males) from the UKHLS. The current study used predictive normative modelling approaches, one-sample t tests, a hierarchical regression, and two multiple regressions. RESULTS The current study found that CHD patients have significantly lower Conscientiousness (t(565) = -3.84, p < 0.001, 95% C.I. [-0.28, -0.09], Cohen's d = -0.16) and SRH (t(565) = -13.83, p < 0.001, 95% C.I. [-0.68, -0.51], and Cohen's d = -0.58) scores compared to age and sex-matched healthy controls. Moreover, health status (controls vs. CHD patients) moderated the links between Neuroticism, Extraversion and SRH. Specifically, Neuroticism (b = -0.03, p < 0.01, 95% C.I. [-0.04, -0.01]), Openness (b = 0.04, p < 0.001, 95% C.I. [0.02, 0.06]), and Conscientiousness (b = 0.08, p < 0.001, 95% C.I. [0.06, 0.10]) were significant predictors of SRH in healthy controls, whereas Conscientiousness (b = 0.08, p < 0.05, 95% C.I. [0.01, 0.16]) and Extraversion (b = -0.09, p < 0.01, 95% C.I. [-0.15, -0.02]) were significant predictors of SRH in CHD patients. CONCLUSION Based on the close associations between personality traits and SRH, and the subsequent impact on patient outcomes, the results of this study should be taken into consideration by clinicians and health professionals when developing tailored treatment and intervention programs for their patients.
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Affiliation(s)
- Weixi Kang
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, London W12 0BZ, UK
| | - Antonio Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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Self-rated health and chronic inflammation are related and independently associated with hospitalization and long-term mortality in the general population. Sci Rep 2022; 12:19761. [PMID: 36396700 PMCID: PMC9670062 DOI: 10.1038/s41598-022-24422-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
The subjective indicator of health self-rated health (SRH) and the chronic inflammation biomarker soluble urokinase plasminogen activator receptor (suPAR) are both robust predictors of healthcare use and mortality. However, the possible relationship between SRH and suPAR in the assessment of hospitalization and mortality risk is unknown. We used data from the Danish population-based Inter99 cohort to examine the association between SRH and suPAR and test their individual and combined associations with 2-year risk of acute hospitalization and 5- and 15-year mortality. SRH and serum suPAR levels were measured in 5490 participants (median age 45.1 years, 48.7% men). Poorer SRH was associated with elevated suPAR. In unadjusted analyses, SRH and suPAR were individually associated with higher risks of acute hospitalization and mortality, and both measures remained independently associated with higher risks of hospitalization and 15-year mortality after mutual adjustments. The association of suPAR with mortality was stronger in poorer SRH categories, and when combined, SRH and suPAR could identify different groups of individuals with increased risk of acute hospitalization and mortality. Both SRH and suPAR were independently associated with risk of acute hospitalization and mortality, and different combinations of the two measures could identify different groups of individuals at increased risk.
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Mitochondria-Targeted Human Catalase in the Mouse Longevity MCAT Model Mitigates Head-Tilt Bedrest-Induced Neuro-Inflammation in the Hippocampus. Life (Basel) 2022; 12:life12111838. [DOI: 10.3390/life12111838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Microgravity (modeled by head-tilt bedrest and hind-limb unloading), experienced during prolonged spaceflight, results in neurological consequences, central nervous system (CNS) dysfunction, and potentially impairment during the performance of critical tasks. Similar pathologies are observed in bedrest, sedentary lifestyle, and muscle disuse on Earth. In our previous study, we saw that head-tilt bedrest together with social isolation upregulated the milieu of pro-inflammatory cytokines in the hippocampus and plasma. These changes were mitigated in a MCAT mouse model overexpressing human catalase in the mitochondria, pointing out the importance of ROS signaling in this stress response. Here, we used a head-tilt model in socially housed mice to tease out the effects of head-tilt bedrest without isolation. In order to find the underlying molecular mechanisms that provoked the cytokine response, we measured CD68, an indicator of microglial activation in the hippocampus, as well as changes in normal in-cage behavior. We hypothesized that hindlimb unloading (HU) will elicit microglial hippocampal activations, which will be mitigated in the MCAT ROS-quenching mice model. Indeed, we saw an elevation of the activated microglia CD68 marker following HU in the hippocampus, and this pathology was mitigated in MCAT mice. Additionally, we identified cytokines in the hippocampus, which had significant positive correlations with CD68 and negative correlations with exploratory behaviors, indicating a link between neuroinflammation and behavioral consequences. Unveiling a correlation between molecular and behavioral changes could reveal a biomarker indicative of these responses and could also result in a potential target for the treatment and prevention of cognitive changes following long space missions and/or muscle disuse on Earth.
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Knight EL. Two Routes to Status, One Route to Health: Trait Dominance and Prestige Differentially Associate with Self-reported Stress and Health in Two US University Populations. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022; 8:461-488. [PMID: 36034092 PMCID: PMC9395955 DOI: 10.1007/s40750-022-00199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022]
Abstract
Objective Social status has been extensively linked to stress and health outcomes. However, two routes by which status can be earned – dominance and prestige – may not uniformly relate to lower stress and better health because of inherent behavioral and stress-exposure differences in these two routes. Methods In one exploratory and two preregistered studies, participants (total N = 978) self-reported their trait dominance and prestige and self-reported several stress and health outcomes. Results The meta-effects evident across the three studies indicate that higher trait dominance was associated with worse outcomes – higher stress, poorer physical and mental health, poorer behavioral health, poorer life satisfaction, higher negative affect (range of absolute values of non-zero correlations, |r| = [0.074, 0.315], ps < 0.021) – and higher trait prestige was associated with better outcomes – lower stress, better physical and mental health, better behavioral health, better life satisfaction, higher positive and lower negative mood (|r| = [0.134, 0.478], ps < 0.001). These effects remained evident (with few exceptions) after controlling for socioeconomic status, other status-relevant traits, or self-enhancing motives; associations with behavior relevant to the COVID19 pandemic generally were not robust. Conclusions This work indicates that evolved traits related to the preferred route by which status is earned likely impact self-reported stress and health outcomes. Future research is necessary to examine physiological and other objective indicators of stress and health in more diverse populations. Supplementary Information The online version contains supplementary material available at 10.1007/s40750-022-00199-3.
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Kryczyk-Kozioł J, Prochownik E, Błażewska-Gruszczyk A, Słowiaczek M, Sun Q, Schomburg L, Ochab E, Bartyzel M, Zagrodzki P. Assessment of the Effect of Selenium Supplementation on Production of Selected Cytokines in Women with Hashimoto’s Thyroiditis. Nutrients 2022; 14:nu14142869. [PMID: 35889825 PMCID: PMC9317246 DOI: 10.3390/nu14142869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023] Open
Abstract
The impact of selenium on the course of Hashimoto’s thyroiditis (HT) was mainly assessed by monitoring the titer of antithyroid autoantibodies in most of the studies conducted hitherto. On the other hand, the imbalance in activity of T cells such as Th1, Th2, Th17, and Treg may be relevant in the pathogenesis of this disease. Hence, the assessment of changes in the secretion of cytokines by these cells during selenium supplementation in patients with HT seems to be an important issue and was the main goal of this study. A further aim was to search for correlations among these cytokines, as well as markers of thyroid function, selenium/iodine status in the body, and other biochemical parameters. The group of 29 women with newly diagnosed Hashimoto’s thyroiditis was supplemented with selenium in a dose of 100 µg/day for 6 months. Immunological parameters: interferon γ, tumor necrosis factor α, chemokine CXCL10, interleukin 4, interleukin 1β, interleukin 17, transforming growth factor β, and C-reactive protein, as well as selenium status parameters were determined in serum twice, i.e., before and after supplementation. Selenium supplementation was associated with a change in the production of two cytokines: interferon γ and interleukin 1β, for which a decrease and an increase in concentration were observed, respectively. The partial least squares (PLS) model revealed the presence of many relevant correlations among analyzed parameters. The stage of HT development, degree of thyroid dysfunction, and selenium supplementation of diet are interdependent factors which shape the profile of some cytokines secreted by cells participating in the autoimmunity process.
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Affiliation(s)
- Jadwiga Kryczyk-Kozioł
- Department of Food Chemistry and Nutrition, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (E.P.)
| | - Ewelina Prochownik
- Department of Food Chemistry and Nutrition, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (E.P.)
| | | | - Marian Słowiaczek
- Medical Center DIAGNOZA, Zaczarowane Koło 5, 30-087 Kraków, Poland; (A.B.-G.); (M.S.)
| | - Qian Sun
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (Q.S.); (L.S.)
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (Q.S.); (L.S.)
| | - Ewa Ochab
- Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland;
| | - Mirosław Bartyzel
- Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Kraków, Poland;
| | - Paweł Zagrodzki
- Department of Food Chemistry and Nutrition, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland; (J.K.-K.); (E.P.)
- Correspondence: ; Tel.: +48-12-620-56-71; Fax: +48-12-620-56-93
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de Vries LP, van de Weijer MP, Bartels M. The human physiology of well-being: A systematic review on the association between neurotransmitters, hormones, inflammatory markers, the microbiome and well-being. Neurosci Biobehav Rev 2022; 139:104733. [PMID: 35697161 DOI: 10.1016/j.neubiorev.2022.104733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/09/2022] [Accepted: 06/07/2022] [Indexed: 02/08/2023]
Abstract
To understand the pathways through which well-being contributes to health, we performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines on the association between well-being and physiological markers in four categories, neurotransmitters, hormones, inflammatory markers, and microbiome. We identified 91 studies. Neurotransmitter studies (knumber of studies=9) reported only a possible positive association between serotonin and well-being. For the hormone studies (k = 48), a lower momentary cortisol level was related to higher well-being (meta-analytic r = -0.06), and a steeper diurnal slope of cortisol levels. Inflammatory marker studies (k = 36) reported negative or non-significant relations with well-being, with meta-analytic estimates of respectively r = -0.07 and r = -0.05 for C-reactive protein and interleukin-6. Microbiome studies (k = 4) reported inconsistent associations between different bacteria abundance and well-being. The results indicate possible but small roles of serotonin, cortisol, and inflammatory markers in explaining differences in well-being. The inconsistent and limited results for other markers and microbiome require further research. Future directions for a complete picture of the physiological factors underlying well-being are proposed.
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Affiliation(s)
- Lianne P de Vries
- Department of Biological Psychology, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | - Margot P van de Weijer
- Department of Biological Psychology, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Meike Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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Inoue Y, Nakata A, Kurioka S, Nagata T, Mori K. [Association of self-rated health with inflammatory markers among nursing home employees]. SANGYŌ EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2021; 63:117-128. [PMID: 33087634 DOI: 10.1539/sangyoeisei.2020-020-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although self-rated health (SRH), the self-evaluation of one's own health status, has been reported to be associated with the immune status, the relationship between three different SRH measures (global, self-comparative, and age-comparative) with inflammatory markers as well as the relative strength of these associations by age are not well understood. The current study investigated the associations between SRH measures and inflammatory markers among nursing home employees. METHODS A sample of 120 Japanese employees at a nursing home (90 women and 30 men), aged 21-68 years (mean, 40.9 years), underwent a blood test for the measurement of inflammatory markers (interferon-γ, interleukin [IL]-4, IL-6, and tumor necrosis factor [TNF]-α, white blood cell count) and SRH during the annual health checkup. Multiple regression analysis adjusted for covariates was performed to analyze the relationship between inflammatory markers and SRH measures stratified by age, that is, aged < 40 years (younger age group) and 40 years and over (older age group). RESULTS Among the participants aged 40 years and over, poor global SRH was significantly associated with an increase in IL-6, while poor age-comparative SRH was significantly associated with an increase in TNF-α among participants aged < 40 years in the fully adjusted model controlling for potential confounders. Age-comparative SRH was also significantly associated with an increase in IL-6 among all participants. Self-comparative SRH was not significantly associated with inflammatory markers. CONCLUSIONS Our results suggest that three SRH measures are not equivalently associated with inflammatory markers, especially when the analyses were performed separately for the younger and older populations. This implies that not only differences in forms of SRH but also in age modify the relationship between SRH and inflammatory markers.
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Affiliation(s)
- Yukiko Inoue
- Graduate School of Medicine, International University of Health and Welfare.,Institutional Research Center, University of Occupational and Environmental Health, Japan
| | - Akinori Nakata
- Graduate School of Medicine, International University of Health and Welfare
| | | | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Koji Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
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Physical and Psychological Factors Contributing to Incidental Falls in Older Adults Who Perceive Themselves as Unhealthy: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073738. [PMID: 33918455 PMCID: PMC8038270 DOI: 10.3390/ijerph18073738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/21/2023]
Abstract
Falls have become one of the common causes of morbidity and mortality in the elderly. Advanced age is a strong predictor of falls. Additionally, those who perceive themselves as unhealthy are more likely to suffer from incidental falls in accordance with aging. We aimed to compare individual, physical, and psychological factors between older adults with and without a fall history. Then, we tried to identify physical and psychological variables associated with falls by controlling for individual characteristics. We analyzed public data from the 2017 National Survey of Older Persons in South Korea. Seniors aged 65 years and over who considered themselves in poor health status were eligible. A total of 2765 women and 1280 men (n = 4045) were enrolled, and 940 adults suffered a fall within a year (the average number of falls was 2.5). We applied individual variable-adjusted models and discovered that hearing discomfort (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.09–1.55), limited activities of daily living (ADL) (OR 1.40, 95% CI 1.13–1.74), limited instrumental activities of daily living (IADL) (OR 1.34, 95% CI 1.13–1.61), and depression (OR 1.44, 95% CI 1.23–1.69) significantly increased risk for falls on multivariate logistic regression. Our findings suggest that hearing discomfort, limited ADL/IADL, and depression need to be addressed observantly to prevent falls in the elderly who consider themselves unhealthy.
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Self-rated health in individuals with and without disease is associated with multiple biomarkers representing multiple biological domains. Sci Rep 2021; 11:6139. [PMID: 33731775 PMCID: PMC7969614 DOI: 10.1038/s41598-021-85668-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/01/2021] [Indexed: 12/18/2022] Open
Abstract
Self-rated health (SRH) is one of the most frequently used indicators in health and social research. Its robust association with mortality in very different populations implies that it is a comprehensive measure of health status and may even reflect the condition of the human organism beyond clinical diagnoses. Yet the biological basis of SRH is poorly understood. We used data from three independent European population samples (N approx. 15,000) to investigate the associations of SRH with 150 biomolecules in blood or urine (biomarkers). Altogether 57 biomarkers representing different organ systems were associated with SRH. In almost half of the cases the association was independent of disease and physical functioning. Biomarkers weakened but did not remove the association between SRH and mortality. We propose three potential pathways through which biomarkers may be incorporated into an individual’s subjective health assessment, including (1) their role in clinical diseases; (2) their association with health-related lifestyles; and (3) their potential to stimulate physical sensations through interoceptive mechanisms. Our findings indicate that SRH has a solid biological basis and it is a valid but non-specific indicator of the biological condition of the human organism.
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Tait JL, Bulmer S, Drain JR, Main LC. Associations between inflammatory markers and well-being during 12 weeks of basic military training. Eur J Appl Physiol 2021; 121:849-860. [PMID: 33389139 DOI: 10.1007/s00421-020-04554-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/07/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Stress, anxiety and physical exertion are all closely linked to well-being, and each can alter immune function. Diminished well-being has been observed during military training, however there is mixed evidence regarding whether concomitant changes in inflammatory markers occur, with these phenomena indicating potential maladaptive responses to imposed training loads. The aims of this project were (1) assess changes in inflammation and subjective well-being across a 12-week basic military training (BMT) program, and (2) evaluate relationships between circulating inflammatory markers and well-being. METHODS A total of 37 men and women undergoing 12 weeks of BMT in Australia were recruited. Well-being was assessed via questionnaire (DASS-21), and plasma samples were collected for the analysis of inflammatory cytokines [interleukin (IL)-4, IL-6, IL-1β, IL-8, IL-10, and tumor necrosis factor (TNF)-α] at weeks 1, 4, 8 and 12. Data were analysed using general linear mixed models. RESULTS Depression, anxiety and stress subscale scores all significantly improved (all P ≤ 0.001), and TNF-α decreased (P = 0.031) across time. Compared to baseline (week 1), significant decreases in associations between depression and IL-10, anxiety and IL-10, and stress and IL-10, IL-4 IL-6 and TNF-α (all P < 0.05), were detected across BMT. CONCLUSION The BMT program appears to support improved well-being over the 12 weeks, with minimal perturbation to inflammatory markers. Biomarkers and well-being displayed consistent associations and may have utility as psychophysiological indicators of health status in military research, however for now, subjective measures may represent more cost-effective proxies for ongoing monitoring of military personnel.
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Affiliation(s)
- Jamie L Tait
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Sean Bulmer
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Jace R Drain
- Defence Science and Technology Group, Fishermans Bend, Australia
| | - Luana C Main
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
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Association Between Peripheral Blood Cell Count Abnormalities and Health-Related Quality of Life in the General Population. Hemasphere 2020; 5:e503. [PMID: 33364549 PMCID: PMC7755519 DOI: 10.1097/hs9.0000000000000503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/22/2020] [Indexed: 01/04/2023] Open
Abstract
Complete blood cell counts, including differentials, are widely available and change on aging. Peripheral blood cell counts outside the normal range have previously been associated with increased mortality rates and a number of comorbid conditions. However, data about the association between blood cell count abnormalities, other than anemia, and health-related quality of life (HRQoL) are scarce. We investigated the association between abnormalities in (differential) blood cell counts and HRQoL in 143 191 community-dwelling individuals from the prospective population-based Lifelines cohort. HRQoL was measured using the RAND 36-Item Health Survey. Logistic regression analyses were used to determine the effect of blood cell count abnormalities on the odds of having a lower score than an age- and sex-specific reference value for each domain. Leukocytosis, neutrophilia, and a high neutrophil to lymphocyte ratio were associated with impaired HRQoL across multiple domains, both for younger and older (≥60 years) individuals. Using multivariable models, we confirmed that these associations were independent of the potential confounding factors obesity, smoking, alcohol use, number of medications (as a measure of comorbidity), anemia, and mean corpuscular volume. The impact on HRQoL was most pronounced for high neutrophil levels. Further, high white blood cell counts proved to be a better marker for inferior HRQoL as compared to elevated high-sensitivity C-reactive protein levels. Decreased HRQoL in several domains was also observed for individuals with monocytosis, lymphocytosis, and thrombocytosis. Taken together, the present study demonstrates an association between inflammatory and myeloid-skewed blood cell counts and inferior HRQoL in community-dwelling individuals.
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Chiavarino C, Poggio C, Rusconi F, Beretta AAR, Aglieri S. Psychological factors and self-rated health: An observative study on cardiological patients. J Health Psychol 2019; 24:1993-2002. [DOI: 10.1177/1359105317712591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study investigated the association of illness representations, awareness of bodily states and health complaints to self-rated health in N = 150 consecutive patients with heart disease (ischaemic disease, heart failure and heart valve disease) and explored differences between ‘health optimist’ and ‘health pessimist’ patients. After controlling for medical variables, health complaints accounted for 14.2 per cent of patients’ self-rated health, and illness representations contributed for another 16.2 per cent; body awareness was not associated with self-rated health. Also, ‘optimists’ tended to see less negative consequences from their illness and perceived greater control over illness treatment compared to ‘pessimists’. Targeting symptoms and illness representations may optimize rehabilitation outcomes.
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17
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Bao X, Borné Y, Yin S, Niu K, Orho-Melander M, Nilsson J, Melander O, Engström G. The associations of self-rated health with cardiovascular risk proteins: a proteomics approach. Clin Proteomics 2019; 16:40. [PMID: 31832026 PMCID: PMC6859604 DOI: 10.1186/s12014-019-9258-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Though subjective, poor self-rated health (SRH) has consistently been shown to predict cardiovascular disease (CVD). The underlying mechanism is unclear. This study evaluates the associations of SRH with biomarkers for CVD, aiming to explore potential pathways between poor SRH and CVD. Methods Based on the Malmö Diet and Cancer Cardiovascular Cohort study, a targeted proteomics approach was used to assess the associations of SRH with 88 cardiovascular risk proteins, measured in plasma from 4521 participants without CVD. The false discovery rate (FDR) was controlled using the Benjamini and Hochberg method. Covariates taken into consideration were age, sex, traditional CVD risk factors (low-density lipoprotein cholesterol, systolic blood pressure, anti-hypertensive medication, diabetes, body mass index, smoking), comorbidity, life-style and psycho-social factors (education level, living alone, alcohol consumption, low physical activity, psychiatric medication, sleep duration, and unemployment). Results Age and sex-adjusted associations with SRH was found for 34 plasma proteins. Nine of them remained significant after adjustments for traditional CVD risk factors. After further adjustment for comorbidity, life-style and psycho-social factors, only leptin (β = − 0.035, corrected p = 0.016) and C–C motif chemokine 20 (CCL20; β = − 0.054, corrected p = 0.016) were significantly associated with SRH. Conclusions Poor SRH was associated with raised concentrations of many plasma proteins. However, the relationships were largely attenuated by adjustments for CVD risk factors, comorbidity and psycho-social factors. Leptin and CCL20 were associated with poor SRH in the present study and could potentially be involved in the SRH–CVD link.
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Affiliation(s)
- Xue Bao
- 1Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden.,3Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yan Borné
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Songjiang Yin
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden.,4Department of Orthopedics, Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kaijun Niu
- 3Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Marju Orho-Melander
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Jan Nilsson
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Olle Melander
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Gunnar Engström
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
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Żelaźniewicz A, Nowak J, Pawłowski B. Hand-grip strength predicts individuals' sexual and pathogen but not moral disgust sensitivity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tait JL, Duckham RL, Milte CM, Main LC, Daly RM. Associations between inflammatory and neurological markers with quality of life and well-being in older adults. Exp Gerontol 2019; 125:110662. [PMID: 31323254 DOI: 10.1016/j.exger.2019.110662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/01/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Stressful experiences, poor self-rated health, and negative emotional states have been implicated with higher levels of inflammatory markers and lower levels of neurotrophic factors in some healthy adults and clinical populations, but these relationships are unclear in the elderly. This study aimed to identify the associations between systemic inflammatory and neurological markers with well-being and health-related quality of life (HR-QoL) in independently living elderly people. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 268 men and women aged ≥65 years living independently in retirement communities in Melbourne, Australia. MEASURES Questionnaires were used to assess HR-QoL [Short Form (SF)-36 version 2] and well-being (Personal Wellbeing Index). Serum inflammatory cytokines [interleukin (IL)-4, IL-6, IL-1β, IL-8, IL-10, tumor necrosis factor (TNF)-α, and high sensitive C-reactive protein (hs-CRP)] were standardised to Z-scores and used to calculate pro- and anti-inflammatory composite score and an overall composite inflammatory index. Plasma levels of the neurological markers amyloid β (1-40) and amyloid β (1-42), brain derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF), were also assessed. RESULTS No significant associations were found between any inflammatory or neurological marker with HR-OoL or well-being, with the exception that lower perceptions of the HR-QoL vitality subscale were associated with higher levels of hs-CRP [unstandardized beta-coefficient (β): -1.50; 95% CI: -2.53, -0.46; P = 0.004] and Z-scores in the pro-inflammatory composite score (β = -2.06; 95% CI: -3.49, -0.62; P = 0.005). CONCLUSIONS/IMPLICATIONS In elderly people residing in independent living retirement communities, there was no consistent evidence indicating that circulating inflammatory or neurological markers were associated with the key physical or mental HR-QoL domains or overall well-being. This suggests that these biomarkers may not be effective predictors in relatively healthy communities, and may be more beneficial in frail or clinical populations. Clinical Trials registry: Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). http://www.anzctr.org.au/.
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Affiliation(s)
- Jamie L Tait
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
| | - Rachel L Duckham
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), St. Albans, Melbourne, Victoria, Australia
| | - Catherine M Milte
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Luana C Main
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
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The association between self-rated health and underlying biomarker levels is modified by age, gender, and household income: Evidence from Understanding Society - The UK Household Longitudinal Study. SSM Popul Health 2019; 8:100406. [PMID: 31193358 PMCID: PMC6527907 DOI: 10.1016/j.ssmph.2019.100406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
The goal of this study was to evaluate how self-rated health (SRH) and objective measures of health (biomarkers) are associated, and if this association varies by gender, age, and socioeconomic position (measured by household income). Data come from the UK Household Longitudinal Study nurse visit (2010–2012), including a representative sample of adults in Great Britain (N = 15 687 maximum sample). SRH was assessed by the question “In general, would you say your health is excellent, very good, good, fair, or poor?” and dichotomized into good or poor. Indices were created for four biomarker categories based on the aspects of health they are likely to reflect, including visible weigh-related, fitness, fatigue, and disease risk biomarkers. Logistic regression models were run with SRH as the outcome and each biomarker index as a predictor, adjusting by gender, age, and income. Further, interaction terms between each biomarker index and gender, age, and income (independently) were added to test for effect modification. All biomarker indices were associated with SRH in expected directions, with the fitness index most strongly predicting SRH. Gender, age, or income modified the associations between SRH and all biomarker indices to different extents. The association between the visible weight-related biomarker index (including body mass/fat variables) and SRH was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between SRH and the fitness biomarker index, whereas age modified the association between SRH and the fatigue biomarker index. When using SRH to investigate health inequalities, researchers and policy makers should be clear that different social groups may systematically consider different dimensions of health when reporting their SRH. The association between self-rated global health and underlying objective health as measured by biomarkers varies by type of biomarker, age, sex and socioeconomic status. Biomarkers that measure different aspects of fitness most strongly predicting self-rated health. The association between the visible biomarkers (including body mass/fat variables) and self-rated health was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between self-rated health and biomarkers of disease, with a stronger association for higher income groups. When rating own health individuals from different social groups may systematically consider different dimensions of health.
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Abstract
OBJECTIVE Despite its simplicity, single-item measures of self-rated health have been associated with mortality independent of objective health conditions. However, little is known about the mechanisms potentially responsible for such associations. This study tested the association between self-rated heath and inflammatory markers as biological pathways, and whether sleep quality and/or depression statistically mediated such links. METHOD Eighty-six heterosexual married couples completed a standard measure of self-rated health, the Center of Epidemiological Studies-Depression Scale, and the Pittsburgh Sleep Quality Index. Participants also had blood drawn for determination of plasma levels of interleukin 6 and high-sensitivity C-reactive protein. The Monte Carlo method was used to construct confidence intervals for mediation analyses. RESULTS Results indicated that poor self-rated health was associated with higher CRP levels (B = .31, SE = .14, p = .028). Importantly, the Monte Carlo mediational analyses showed that these results were statistically mediated by sleep quality (aXb = 0.10, 95% confidence interval = 0.003 to 0.217) but not depressive symptoms (aXb = 0.03, 95% confidence interval = -0.03 to 0.10). CONCLUSIONS These results highlight the biological and behavioral mechanisms potentially linking self-rated health to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.
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Lodin K, Lekander M, Petrovic P, Nilsonne G, Hedman-Lagerlöf E, Andreasson A. Cross-sectional associations between inflammation, sickness behaviour, health anxiety and self-rated health in a Swedish primary care population. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219844357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated associations between inflammatory markers, sickness behaviour, health anxiety and self-rated health in 311 consecutive primary care patients. Poor self-rated health was associated with high sickness behaviour ( ρ = 0.28, P < 0.001; ρ = 0.42, P = 0.003) and high health anxiety ( ρ = 0.31, P < 0.001; ρ = –0.32, P = 0.003). High levels of interleukin 6 were associated with poor self-rated health in men ( ρ = 0.26, P = 0.009). Low levels of interleukin-6 were associated with poor self-rated health in women ( ρ = –0.15, P = 0.04), but this association was non-significant when adjusted for health anxiety ( ρ = –0.08, P = 0.31). These results are consistent with the theory that interoceptive processes draw on both inflammatory mediators and the state of sickness behaviour in inferring health state.
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Affiliation(s)
- Karin Lodin
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Nilsonne
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | | | - Anna Andreasson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
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Dinh KM, Kaspersen KA, Mikkelsen S, Pedersen OB, Petersen MS, Thørner LW, Hjalgrim H, Rostgaard K, Ullum H, Erikstrup C. Low-grade inflammation is negatively associated with physical Health-Related Quality of Life in healthy individuals: Results from The Danish Blood Donor Study (DBDS). PLoS One 2019; 14:e0214468. [PMID: 30921429 PMCID: PMC6438577 DOI: 10.1371/journal.pone.0214468] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health-Related Quality of Life (HRQL) represent individuals' subjective assessment of their mental and physical well-being, and is highly predictive of future health. C-reactive protein (CRP) is a well-established marker of inflammation. Low-grade inflammation (LGI), defined as slightly increased CRP levels, is associated with increased risk of several diseases. LGI may reflect subclinical pathology, which could affect individual's subjective health assessment. This study aimed to examine whether LGI has an independent impact on self-reported health or rather is a mediator of a confounder in a large population of healthy individuals. METHODS Plasma CRP levels were measured in 17,024 participants from the Danish Blood Donor Study (DBDS). All participants completed a standard questionnaire including smoking status, and the 12-item short-form health survey (SF-12), which is a widely used scale for HRQL. SF-12 is reported as a mental (MCS) and physical (PCS) score. The relationship between LGI (defined as a plasma CRP level between 3 mg/L and 10 mg/L) and MCS or PCS was explored by mediation analysis and adjusted multivariable linear regression analysis. Multiple imputation modelling was used to remedy missing values. The analyses were stratified according to sex and use of combined oral contraception (OC). RESULTS In the study, 1,542 (10.3%) participants had LGI. PCS was associated with LGI in all strata, i.e. women using OC: RC = -0.36 points lower PCS in participants with LGI vs no LGI, CI: -0.94 to -0.19, women not using OC: RC = -0.63, CI: -1.05 to -0.21 and men: RC = -0.76, CI: -1.10 to -0.42. But LGI had no impact on MCS. Predictors of lower PCS included obesity, current smoking, and waist circumference in all strata. Physical activity in leisure time was the only factor positively associated with PCS. Age and physical activity in leisure time was associated with increased MCS in all strata whereas current smoking was the only strong predictor of a reduction in MCS. Only a small effect of smoking on PCS was mediated through LGI. CONCLUSION In this population of healthy individuals, LGI had independent impact on lower self-rated physical health score in HRQL in both sexes, but was not associated with self-rated mental health score. A small and significant effect of smoking on physical health score was mediated through LGI.
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Affiliation(s)
- Khoa Manh Dinh
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lise Wegner Thørner
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Rostgaard
- Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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Saunders GRB, Elkins IJ, Christensen K, McGue M. The relationship between subjective well-being and mortality within discordant twin pairs from two independent samples. Psychol Aging 2019; 33:439-447. [PMID: 29756801 DOI: 10.1037/pag0000248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prior research has shown robust associations between greater subjective well-being (SWB) and reduced mortality. Whether this observed association is causal in nature or due instead to confounding genetic or environmental factors affecting both SWB and mortality is not well understood. We used a combined sample of 6,802 twins drawn from two cohorts: the Longitudinal Study of Middle-Aged Danish Twins (MADT; N = 2,815, baseline age between 45 and 69 years, M = 56.8, SD = 6.4) and the Longitudinal Study of Aging Danish Twins (LSADT; N = 3,987, baseline age between 70 and 97 years, M = 76.6, SD = 4.9). The relationship between SWB, encompassing measures of life satisfaction and affect, and all-cause mortality was evaluated using survival analyses at both the individual level and within twin pairs. Twin difference analyses were completed within 1,053 monozygotic (MZ) twin pairs and 1,143 dizygotic (DZ) twin pairs to control for genetic and shared environmental confounding. As expected, the individual-level results showed that higher levels of SWB were associated with reduced mortality: affect hazard ratio (HR) = .90, 95% confidence interval (CI) [.87, .94]; life satisfaction HR = .88, 95% CI [.84, .92]. The effect of SWB on reduced mortality remained significant within both MZ and DZ pairs, suggesting that the association is independent of genetic and nonshared environmental confounding factors. These findings, which generalized across both younger (MADT) and older (LSADT) cohorts of adults, remained significant when accounting for demographic factors, physical health, and cognitive functioning. (PsycINFO Database Record
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Affiliation(s)
| | | | - Kaare Christensen
- Danish Twin Registry and Danish Aging Research Center, University of Southern Denmark
| | - Matt McGue
- Department of Psychology, University of Minnesota
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Tamura T, Naito M, Maruyama K, Tsukamoto M, Sasakabe T, Okada R, Kawai S, Hishida A, Wakai K. The association between self-rated health and high-sensitivity C-reactive protein level: a cross-sectional and 5-year longitudinal study. BMC Public Health 2018; 18:1380. [PMID: 30558565 PMCID: PMC6297960 DOI: 10.1186/s12889-018-6251-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background Although self-rated health (SRH) independently predicts mortality, the biological background of this association remains unexplained. This study aimed to examine the association between SRH and serum high-sensitivity C-reactive protein (hsCRP) level. Methods Subjects were 899 participants aged 35–69 years (237 men and 662 women) in the Daiko Study, part of the Japan Multi-Institutional Collaborative Cohort Study. They were enrolled from 2008 to 2010. Of the subjects, 666 participated in a second survey 5 years later. Lifestyle factors and SRH were assessed using a self-administered questionnaire. Serum hsCRP level was measured using a latex-enhanced immunonephelometric assay. The association between SRH and serum hsCRP level was evaluated using a general linear model with covariates. We further longitudinally investigated whether higher serum hsCRP level at baseline predicts poor SRH after 5 years using an unconditional logistic regression model. Results A higher serum hsCRP level was significantly associated with poor SRH at baseline after adjusting for covariates (p for trend = 0.023). The age- and sex-adjusted odds ratio and 95% confidence interval (CI) for poor SRH after 5 years was 1.45 (95% CI: 0.76–2.78) for the highest tertile compared with the lowest tertile of serum hsCRP level at baseline with a significant linear trend (p for trend = 0.033), although the risk increase disappeared after adjustment for other covariates. Conclusions The present study demonstrated that poor SRH is cross-sectionally associated with higher serum hsCRP level. However, the longitudinal data did not support the relationship between serum hsCRP level at baseline and future SRH. Further longitudinal studies that include data on mortality and multiple inflammatory markers are warranted to elucidate the possible role of low-grade inflammation in the association between SRH and mortality risk.
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Affiliation(s)
- Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Mariko Naito
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Oral Epidemiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenta Maruyama
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mineko Tsukamoto
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tae Sasakabe
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Rieko Okada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Sayo Kawai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Lodin K, Lekander M, Syk J, Alving K, Andreasson A. Associations between self-rated health, sickness behaviour and inflammatory markers in primary care patients with allergic asthma: a longitudinal study. NPJ Prim Care Respir Med 2017; 27:67. [PMID: 29255205 PMCID: PMC5735192 DOI: 10.1038/s41533-017-0068-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/17/2017] [Accepted: 11/23/2017] [Indexed: 01/02/2023] Open
Abstract
Allergic asthma is a chronic inflammatory disorder associated with elevated levels of immunoglobulin E (IgE), serum eosinophilic cationic protein (S-ECP), plasma eosinophil-derived neurotoxin (P-EDN) and fraction of exhaled nitric oxide (FENO). Poor self-rated health and sickness behaviour has repeatedly been associated with inflammatory markers, but the nature of this relationship in chronic inflammatory disease is not known. Likewise, such findings largely rely on cross-sectional investigations. Self-rated health (How would you rate your general state of health?), sickness behaviour (mean rating of satisfaction with energy, sleep, fitness, appetite and memory), IgE, S-ECP, P-EDN, and FENO were assessed in 181 non-smoking primary care patients with asthma in a 1-year longitudinal study. Associations between repeated measurements were calculated using mixed regression models and Spearman's correlations for change scores. Poor self-rated health was associated with high levels of seasonal IgE (p = 0.05) and food IgE (p = 0.04), but not total IgE or inflammatory markers. An increase over 1 year in perennial IgE was associated with a worsening of self-rated health (ρ = 0.16, p = 0.04). Poor self-rated health was associated with more pronounced sickness behaviour (p < 0.001), and a worsening in sickness behaviour was associated with a worsening of self-rated health over time (ρ = 0.21, p = 0.007). The study corroborates the importance of sickness behaviour as a determinant of self-rated health by showing that these factors co-vary over a 1-year period in a group of patients with allergic asthma. The importance of specific IgE for perceived health in primary care patients with mild to moderate asthma needs further investigation.
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Affiliation(s)
- Karin Lodin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Jörgen Syk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Andreasson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Psychology, Macquarie University, North Ryde, Australia
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Hedman-Lagerlöf E, Axelsson E, Andersson E, Ljótsson B, Andreasson A, Lekander M. The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial. J Psychosom Res 2017; 103:9-14. [PMID: 29167052 DOI: 10.1016/j.jpsychores.2017.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Self-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety. METHODS Data were collected from a randomized controlled trial where participants with SHA were allocated to 12weeks of exposure-based CBT (n=99) for SHA or to a no treatment control condition (n=33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase. RESULTS Linear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z=2.69, p=0.007). The controlled effect size was moderately large (d=0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH. CONCLUSIONS 12weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.
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Affiliation(s)
- Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
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Longitudinal co-variations between inflammatory cytokines, lung function and patient reported outcomes in patients with asthma. PLoS One 2017; 12:e0185019. [PMID: 28915273 PMCID: PMC5600400 DOI: 10.1371/journal.pone.0185019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/04/2017] [Indexed: 11/19/2022] Open
Abstract
Background Asthma is a chronic inflammatory respiratory disorder associated with reduced lung function and poor quality of life. The condition is also associated with poor self-rated health, a major predictor of objective health trajectories. Of biological correlates to self-rated health, evidence suggests a role for inflammatory cytokines and related sickness behaviours. However, this is mainly based on cross-sectional data, and the relation has not been investigated in patients with chronic inflammatory conditions. Objective To investigate inflammatory cytokines, lung function, sickness behaviour and asthma-related quality of life as determinants of self-rated health in patients with asthma, and to investigate if these variables co-vary over time. Methods Plasma cytokines (IL-5, IL-6), lung function (FEV1), sickness behaviour, asthma-related quality of life and self-rated health were assessed in 181 patients with allergic asthma aged 18–64 years in a one-year longitudinal study. Mixed effect regression models and Spearman’s correlation were performed to analyse the associations between repeated measurements. Results More sickness behaviour and poorer asthma-related quality of life were associated with poorer self-rated health (p’s<0.001). In men, both low and high levels of interleukin (IL)-6 and poorer lung function were related with poorer self-rated health (p’s<0.05). Over the year, improved asthma-related quality of life was associated with better self-rated health (Spearman’s rho = -0.34 women,-0.36 men, p’s<0.01). Further, if sickness behaviour decreased, self-rated health improved, but only in women (Rho = -0.21, p<0.05). Increased FEV1 in men was associated with an increase in IL-6 (Rho = 0.24, p<0.05) as well as improved self-rated health (Rho = -0.21, p<0.05) and asthma-related quality of life (Rho = 0.29, p<0.01) over the year. Conclusion The study highlights the importance of subjectively perceived sickness behaviour and asthma-related quality of life together with lung function as determinants of self-rated health in asthmatic patients. The importance of inflammatory activation for patient reported outcomes in chronic inflammatory conditions need further investigation.
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Cytokines of the IL-1 family: recognized targets in chronic inflammation underrated in organ transplantations. Clin Sci (Lond) 2017; 131:2241-2256. [DOI: 10.1042/cs20170098] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023]
Abstract
Interleukin 1 (IL-1) family is a group of cytokines with multiple local and systemic effects, which regulates both innate and adaptive immune responses. Generally, most IL-1 family cytokines express prevailing pro-inflammatory activities (IL-1α, IL-1β, IL-18, IL-33, IL-36 α, β, γ), whereas others are anti-inflammatory (IL-1Ra (IL-1 receptor antagonist), IL-36Ra, IL-38, IL-37). In addition to their immunomodulatory roles, some of them are also involved in the physiological modulation of homeostatic processes and directly affect mRNA transcription. IL-1 family cytokines bind to specific receptors composed of a ligand-binding chain and an accessory chain. The pro-inflammatory effects of IL-1 family cytokines are regulated on the level of transcription, enzymatic processing of precursors, release of soluble antagonists, and expression of decoy receptors. Members of the IL-1 family regulate the recruitment and activation of effector cells involved in innate and adaptive immunity, but they are also involved in the pathogenesis of chronic disorders, including inflammatory bowel disease, rheumatoid arthritis, and various autoimmune and autoinflammatory diseases. There are only limited data regarding the role of IL-1 cytokines in transplantation. In recent years, targeted therapeutics affecting IL-1 have been used in multiple clinical studies. In addition to the recombinant IL-1Ra, anakinra (highly effective in autoinflammatory diseases and tested for other chronic diseases), the monoclonal antibodies canakinumab, gevokizumab, and rilonacept (a long-acting IL-1 receptor fusion protein) provide further options to block IL-1 activity. Furthermore, new inhibitors of IL-18 (GSK 1070806, ABT-325, rIL-18BP (IL-18 binding protein)) and IL-33 (CNTO-7160) are presently under clinical studies and other molecules are being developed to target IL-1 family cytokines.
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30
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Dhamoon MS, Cheung YK, Moon YP, Wright CB, Willey JZ, Sacco R, Elkind MS. C-reactive protein is associated with disability independently of vascular events: the Northern Manhattan Study. Age Ageing 2017; 46:77-83. [PMID: 28181636 DOI: 10.1093/ageing/afw179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background High-sensitivity C-reactive protein (CRP) has been associated with cardiovascular events and mortality, but the association of CRP with functional status is not well defined. We hypothesised that serum levels of high-sensitivity CRP are associated with long-term trajectories of functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up. Design Prospective, population-based. Setting Northern Manhattan Study. Participants Stroke-free participants aged ≥40 years. Measurements Annual assessments of disability with the Barthel index (BI) for a median of 13 years. BI was analysed as a continuous variable (range 0–100). Baseline demographics, risk factors and laboratory studies were collected, including CRP (n = 2,240). Separate generalised estimating equation models estimated standardised associations between CRP and (i) baseline functional status and (ii) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. Results Mean age was 69 (SD 10) years, 36% were male, 55% Hispanic, 75% hypertensive and 21% diabetic; 337 MIs and 369 first strokes occurred during follow-up. Mean CRP level was 5.24 mg/l (SD 8.86). logCRP was associated with baseline BI (−0.34 BI points per unit logCRP, 95% confidence interval −0.62, −0.06) but not with change over time. Conclusions In this large population-based study, higher serum CRP levels were associated with higher baseline disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Systemic inflammation may contribute to disability independently of clinical vascular events.
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Affiliation(s)
- Mandip S Dhamoon
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | | | - Yeseon P Moon
- Biostatistics, Columbia University, New York, NY, USA
| | | | | | - Ralph Sacco
- Medicine, University of Miami, Miami, FL, USA
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Murdock KW, Fagundes CP, Peek MK, Vohra V, Stowe RP. The effect of self-reported health on latent herpesvirus reactivation and inflammation in an ethnically diverse sample. Psychoneuroendocrinology 2016; 72:113-8. [PMID: 27398881 PMCID: PMC5116910 DOI: 10.1016/j.psyneuen.2016.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 02/05/2023]
Abstract
Self-rated health (SRH) is a reliable predictor of health outcomes including morbidity and mortality. Immune dysregulation is one hypothesized mechanism underlying the association between SRH and health outcomes. Indeed, poorer SRH is associated with greater inflammation. The association between SRH and reactivation of latent herpesviruses is unknown, representing an important gap in the literature given that reactivation of latent herpesviruses leads to enhanced inflammation. The present study addressed this important gap in the literature by examining associations between SRH, inflammation (i.e., peripheral cytokines in the blood), and reactivation of latent herpesviruses among a sample of 1208 individuals participating in the Texas City Stress and Health Study. Participants completed a self-report measure of SRH and a blood draw. Results indicated that higher SRH was associated with lower reactivation of latent herpesviruses and inflammation. Moreover, reactivation of latent herpesviruses partially mediated the association between SRH and inflammation. Accordingly, findings add to our growing understanding of the association between SRH and immune dysfunction.
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Affiliation(s)
- Kyle W. Murdock
- Department of Psychology, Rice University, 6500 Main Street, Houston, TX 77005, USA
| | - Christopher P. Fagundes
- Department of Psychology, Rice University, 6500 Main Street, Houston, TX 77005, USA
,Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030, USA
,Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, Texas 77030 , USA
| | - M. Kristen Peek
- Department of Preventative Medicine and Community Health, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Vansh Vohra
- Department of Psychology, Rice University, 6500 Main Street, Houston, TX 77005, USA
| | - Raymond P. Stowe
- Microgen Laboratories, 903 Texas Avenue, La Marque, TX 77568, USA
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Mills PJ, Wilson KL, Pung MA, Weiss L, Patel S, Doraiswamy PM, Peterson CT, Porter V, Schadt E, Chopra D, Tanzi RE. The Self-Directed Biological Transformation Initiative and Well-Being. J Altern Complement Med 2016; 22:627-34. [DOI: 10.1089/acm.2016.0002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Paul J. Mills
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Fellow, Samueli Institute, Alexandria, VA
| | - Kathleen L. Wilson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Meredith A. Pung
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | | | - Sheila Patel
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | | | - Christine Tara Peterson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | - Valencia Porter
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | - Eric Schadt
- Genetics and Genomics Sciences, Mount Sinai Hospital, New York, NY
| | - Deepak Chopra
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- The Chopra Center for Wellbeing, Carlsbad, CA
| | - Rudolph E. Tanzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Andreasson A, Wicksell RK, Lodin K, Karshikoff B, Axelsson J, Lekander M. A global measure of sickness behaviour: Development of the Sickness Questionnaire. J Health Psychol 2016; 23:1452-1463. [PMID: 27458105 DOI: 10.1177/1359105316659917] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Symptoms after inflammatory activation, so-called sickness behaviour, overlap with trans-diagnostic complaints. As no self-report questionnaire to assess sickness behaviour exists, we aimed to develop such an instrument, the Sickness Questionnaire. Items responsive to experimentally induced inflammatory activation (randomized double-blind study endotoxin (0.6 ng/kg) versus placebo, n = 52) were selected and the statistical properties were examined in 172 primary care patients. A principal component analysis indicated a one-factor solution (Cronbach's alpha = .86). This 10-item scale correlated with depression ( β = .41, p < .001), anxiety ( β = .36, p < .001), self-rated health ( β = .28, p < .001) and a single item of feeling sick ( β = .55, p < .001). The results support the adequacy of Sickness Questionnaire as a brief assessment instrument of perceived sickness behaviour.
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Affiliation(s)
- Anna Andreasson
- 1 Karolinska Institutet, Sweden.,2 Stockholm University, Sweden
| | - Rikard K Wicksell
- 1 Karolinska Institutet, Sweden.,3 Karolinska University Hospital, Sweden
| | | | | | - John Axelsson
- 1 Karolinska Institutet, Sweden.,2 Stockholm University, Sweden
| | - Mats Lekander
- 1 Karolinska Institutet, Sweden.,2 Stockholm University, Sweden
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Hu YN, Chen PC, Hsu CC, Yu HK, Chien KL, Li CC, Hu GC. Age and Gender Differences in the Relationship Between Self-rated Health and Mortality Among Middle-aged and Elderly People in Taiwan—Results of a National Cohort Study. INT J GERONTOL 2016. [DOI: 10.1016/j.ijge.2014.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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35
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Arnberg FK, Lekander M, Morey JN, Segerstrom SC. Self-rated health and interleukin-6: Longitudinal relationships in older adults. Brain Behav Immun 2016; 54:226-232. [PMID: 26872420 PMCID: PMC4828288 DOI: 10.1016/j.bbi.2016.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Both self-rated health (SRH) and inflammation are implicated in chronic diseases and premature mortality. Better SRH is associated with lower proinflammatory cytokines, but there is little evidence about whether this relationship is more stable or dynamic. OBJECTIVE To study the between- and within-person associations between SRH and IL-6. METHODS Older adults (N=131; Mage=75 years) rated their health and provided blood samples for analysis of IL-6 at separate occasions every 6 months over a period up to 5 years. Age, sex, BMI, neuroticism, and statin use were examined as covariates in multilevel models. RESULTS In bivariate models, better SRH, lower BMI, younger age, and female sex correlated with lower IL-6. In multilevel models, stable SRH (between-person differences; p<.001) but not dynamic SRH (within-person changes; p=.93) correlated with IL-6. The stable relationship persisted with demographic and health covariates in the model. CONCLUSIONS Better stable SRH but not dynamic SRH was robustly associated with lower IL-6 among older adults, lending support to previous cross-sectional findings on the relation between inflammatory markers and SRH. The findings suggest that trait-like mechanisms, rather than changes over a time scale of 6-month waves, govern this association. To further investigate the mechanisms behind the SRH-IL-6 association, studies with different measurement frequencies, higher within-person variability, and experimental approaches are warranted.
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Affiliation(s)
- Filip K. Arnberg
- Stress Research Institute, Stockholm University, 106 91 Stockholm, Sweden
,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mats Lekander
- Stress Research Institute, Stockholm University, 106 91 Stockholm, Sweden; Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Jennifer N. Morey
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY, 40506-0044
| | - Suzanne C. Segerstrom
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY, 40506-0044
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36
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Warnoff C, Lekander M, Hemmingsson T, Sorjonen K, Melin B, Andreasson A. Is poor self-rated health associated with low-grade inflammation in 43,110 late adolescent men of the general population? A cross-sectional study. BMJ Open 2016; 6:e009440. [PMID: 27113233 PMCID: PMC4853986 DOI: 10.1136/bmjopen-2015-009440] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Self-rated health is a powerful predictor of long-term health and mortality, hence the importance of a better understanding of its biological determinants. Previous studies have shown that low-grade inflammation is associated with poor self-rated health in clinical and healthy populations, but the evidence is sparse in men and completely lacking for men in late adolescence. The aim of this study was to investigate the association between low-grade inflammation and self-rated health among conscripts. It was hypothesised that high levels of inflammatory factors would be associated with poor self-rated health. DESIGN Data from 49,321 men (18-21 years) conscripted for military service in 1969 and 1970 were used. Inflammation had been measured through erythrocyte sedimentation rate (ESR). Self-rated health had been assessed on a five-point scale, and was dichotomised into Good ('Very good'/'Good'/'Fair') versus Poor ('Poor'/'Very poor'). Data from 43,110 conscripts with normal levels of ESR, and who reported self-rated health remained after exclusion of those with ESR <1 and >11 mm/h. Associations were calculated using logistic regression analyses. Adjustments were made for body mass index, socioeconomic position, inflammatory disease, emotion regulation, smoking, risky use of alcohol and physical activity. RESULTS High levels of ESR were associated with higher odds for poor self-rated health (OR: 1.077 for each unit mm/h increase in ESR, 95% CI 1.049 to 1.105). CONCLUSIONS The present study shows for the first time a significant association between a marker of inflammation and self-rated health in late adolescent men, adding to evidence of an association between low-grade inflammation and subjective health perception also in men, as previously demonstrated in women. Further support for inflammation as part of a general psychobiological process that underpins subjective health perception is hereby provided.
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Affiliation(s)
- Carin Warnoff
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Hemmingsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Kimmo Sorjonen
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bo Melin
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Family Medicine, Karolinska Institutet, Huddinge, Sweden
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Heneka MT, Carson MJ, El Khoury J, Landreth GE, Brosseron F, Feinstein DL, Jacobs AH, Wyss-Coray T, Vitorica J, Ransohoff RM, Herrup K, Frautschy SA, Finsen B, Brown GC, Verkhratsky A, Yamanaka K, Koistinaho J, Latz E, Halle A, Petzold GC, Town T, Morgan D, Shinohara ML, Perry VH, Holmes C, Bazan NG, Brooks DJ, Hunot S, Joseph B, Deigendesch N, Garaschuk O, Boddeke E, Dinarello CA, Breitner JC, Cole GM, Golenbock DT, Kummer MP. Neuroinflammation in Alzheimer's disease. Lancet Neurol 2015; 14:388-405. [PMID: 25792098 DOI: 10.1016/s1474-4422(15)70016-5] [Citation(s) in RCA: 3723] [Impact Index Per Article: 413.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasing evidence suggests that Alzheimer's disease pathogenesis is not restricted to the neuronal compartment, but includes strong interactions with immunological mechanisms in the brain. Misfolded and aggregated proteins bind to pattern recognition receptors on microglia and astroglia, and trigger an innate immune response characterised by release of inflammatory mediators, which contribute to disease progression and severity. Genome-wide analysis suggests that several genes that increase the risk for sporadic Alzheimer's disease encode factors that regulate glial clearance of misfolded proteins and the inflammatory reaction. External factors, including systemic inflammation and obesity, are likely to interfere with immunological processes of the brain and further promote disease progression. Modulation of risk factors and targeting of these immune mechanisms could lead to future therapeutic or preventive strategies for Alzheimer's disease.
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Affiliation(s)
- Michael T Heneka
- Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany; German Center for Neurodegnerative Diseases (DZNE), Bonn, Germany.
| | - Monica J Carson
- Division of Biomedical Sciences, Center for Glial-Neuronal Interactions, University of California, Riverside, CA, USA
| | - Joseph El Khoury
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Gary E Landreth
- Alzheimer Research Laboratory, Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Andreas H Jacobs
- Department of Geriatrics, Johanniter Hospital, Bonn, Germany; European Institute for Molecular Imaging (EIMI) at the Westfalian Wilhelms University (WWU), Münster, Germany
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA; Center for Tissue Regeneration, Repair, and Restoration, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Javier Vitorica
- Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Consejo Superior de Investigaciones Cientificas Universidad de Sevilla, Sevilla, Spain
| | - Richard M Ransohoff
- Department of Neuroscience, Neuroinflammation Research Center, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Karl Herrup
- Division of Life Science, Hong Kong University of Science and Technology, Hong Kong
| | - Sally A Frautschy
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, the Geriatric, Research, and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - Bente Finsen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Guy C Brown
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Alexei Verkhratsky
- Faculty of Life Sciences, The University of Manchester, Manchester, UK; Achucarro Center for Neuroscience, Basque Foundation for Science (IKERBASQUE), Bilbao, Spain; Department of Neurosciences, University of the Basque Country UPV/EHU (Euskal Herriko Unibertsitatea/Universidad del País Vasco) and CIBERNED (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas), Leioa, Spain
| | - Koji Yamanaka
- Research Institute of Environmental Medicine, Nagoya University/RIKEN Brain Science Institute, Wako-shi, Japan
| | - Jari Koistinaho
- Department of Neurobiology, AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eicke Latz
- German Center for Neurodegnerative Diseases (DZNE), Bonn, Germany; Institute of Innate Immunity, University of Bonn, Bonn, Germany; Department of InfectiousDiseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Annett Halle
- Max-Planck Research Group Neuroimmunology, Center of Advanced European Studies and Research (CAESAR), Bonn, Germany
| | - Gabor C Petzold
- Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany; German Center for Neurodegnerative Diseases (DZNE), Bonn, Germany
| | - Terrence Town
- Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Dave Morgan
- Department of Molecular Pharmacology and Physiology, Byrd Alzheimer's Institute, University of South Florida College of Medicine, Tampa, FL, USA
| | - Mari L Shinohara
- Department of Immunology, Duke University Medical Center, Durham, NC, USA
| | - V Hugh Perry
- School of Biological Sciences, Southampton General Hospital, Southampton, UK
| | - Clive Holmes
- Clinical and Experimental Science, University of Southampton, Southampton, UK; Memory Assessment and Research Centre, Moorgreen Hospital, Southern Health Foundation Trust, Southampton, UK
| | - Nicolas G Bazan
- Louisiana State University Neuroscience Center of Excellence, Louisiana State University Health Sciences Center School of Medicine in New Orleans, LA, USA
| | - David J Brooks
- Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Stéphane Hunot
- Centre National de la Recherche Scientifique (CNRS), UMR 7225, Experimental Therapeutics of Neurodegeneration, Paris, France
| | - Bertrand Joseph
- Department of Oncology Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaus Deigendesch
- Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Olga Garaschuk
- Institute of Physiology II, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Erik Boddeke
- Department of Neuroscience, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - John C Breitner
- Centre for Studies on Prevention of Alzheimer's Disease, Douglas Mental Health University Institute, and the McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Greg M Cole
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, the Geriatric, Research, and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - Douglas T Golenbock
- Department of InfectiousDiseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Markus P Kummer
- Department of Neurology, University Hospital Bonn, University of Bonn, Bonn, Germany
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Rosenzveig A, Kuspinar A, Daskalopoulou SS, Mayo NE. Toward patient-centered care: a systematic review of how to ask questions that matter to patients. Medicine (Baltimore) 2014; 93:e120. [PMID: 25396331 PMCID: PMC4616320 DOI: 10.1097/md.0000000000000120] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Clinicians rarely systematically document how their patients are feeling. Single item questions have been created to help obtain and monitor patient relevant outcomes, a requirement of patient-centered care.The objective of this review was to identify the psychometric properties for single items related to health aspects that only the patient can report (health perception, stress, pain, fatigue, depression, anxiety, and sleep quality). A secondary objective was to create a bank of valid single items in a format suitable for use in clinical practice.Data sources used were Ovid MEDLINE (1948 to May 2013), EMBASE (1960 to May 2013), and the Cumulative Index to Nursing and Allied Health Literature (1960 to May 2013).For the study appraisal, 24 articles were systematically reviewed. A critical appraisal tool was used to determine the quality of articles.Items were included if they were tested as single items, related to the construct, measured symptom severity, and referred to recent experiences.The psychometric properties of each item were extracted. Validity and reliability was observed for the items when compared with clinical interviews or well-validated measures. The items for general health perception and anxiety showed weak to moderate strength correlations (r = 0.28-0.70). The depression and stress items showed good area under the receiver operating characteristic curve of 0.85 and 0.73-0.88, respectively, with high sensitivity and specificity. The fatigue item demonstrated a strong effect size and correlations up to r = 0.80. The 2 pain items and the sleep item showed high reliability (intraclass correlation coefficient [ICC] = 0.85, κ = 0.76, ICC = 0.9, respectively).The search targeted articles about psychometric properties of single items. Articles that did not have this as the primary objective may have been missed. Furthermore, not all the articles included had the complete set of psychometric properties for each item.There is sufficient evidence to warrant the use of single items in clinical practice. They are simple, easily implemented, and efficient and thus provide an alternative to multi-item questionnaires. To facilitate their use, the top performing items were combined into the visual analog health states, which provides a quick profile of how the patient is feeling. This information would be useful for regular long-term monitoring.
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Affiliation(s)
- Alicia Rosenzveig
- Division of Clinical Epidemiology (AR, NEM), McGill University Health Centre; School of Physical and Occupational Therapy (AK, NEM); and Department of Medicine (SSD), Faculty of Medicine, McGill University, Montreal, QC, Canada
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Barclay R, Ripat J, Mayo N. Factors describing community ambulation after stroke: a mixed-methods study. Clin Rehabil 2014; 29:509-21. [DOI: 10.1177/0269215514546769] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
Abstract
Objective: To develop a model of community ambulation after stroke based on: Canadian data from community-dwelling individuals post-stroke; the experiences and opportunities for community ambulation expressed by individuals with stroke; and current literature. The model presents a visual depiction of the relationships between the different factors of community ambulation after stroke. Design: A quantitative/qualitative explanatory sequential mixed-methods design was utilized. Secondary data analysis with structural equation modeling resulted in a community ambulation model. Two focus groups of individuals with stroke were conducted to verify and explain the model. Setting: Community. Subjects: Quantitative data from 227 participants: 142 (63%) male; 63.4 (12.0) years of age and 2.6 (2.5) years post stroke. Eleven individuals participated in the focus groups: 6 (55%) male; 61.4 (6.9) years of age and 5.8 (3.3) years since stroke. Main measures: Model variables: items from the EuroQol, Preference Based Stroke Index, gait speed, Reintegration to Normal Living Index, the Community Health Activities Model Program for Seniors, and the Geriatric Depression Scale. Results: The model had reasonable fit with three latent variables: ambulation, gait speed, and health perceptions (normed χ2 = 1.8, root mean square error of approximation = 0.060 (0.043; 0.075)). Depression was also a component of community ambulation. Participants verified the model and added endurance and the environment as additional components. Participants used self-awareness and knowledge of the environment to engage in cognitive strategies related to community ambulation. Conclusions A model of community ambulation after stroke was developed and verified. Recognizing important components of community ambulation may assist physiotherapists in determining community ambulation goals, needs, and opportunities in partnership with clients.
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Affiliation(s)
- Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, University of Winnipeg, Manitoba, Manitoba, Canada
| | - Nancy Mayo
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Research Scientist, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Olsson LA, Hurtig-Wennlöf A, Nilsson TK. Subjective well-being in Swedish active seniors and its relationship with physical activity and commonly available biomarkers. Clin Interv Aging 2014; 9:1233-9. [PMID: 25114517 PMCID: PMC4122258 DOI: 10.2147/cia.s63198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical activity is claimed to be related to well-being and to a lower risk of cardiovascular disease. Therefore, the possible associations of well-being with physical activity and biomarkers of somatic health were studied in a sample of Swedish active seniors to determine the strength of these associations. METHODS Three hundred and eighty-nine community-dwelling senior citizens (127 men and 262 women) of mean age 74 ± 5 years were recruited for this cross-sectional population study. Serum samples were analyzed for lipoproteins and markers of inflammation. The Psychological General Well-Being (PGWB) index was used to measure subjective well-being. Physical activity was assessed by the International Physical Activity Questionnaire modified for the elderly. RESULTS More than 50% of men and women rated their physical activity as high; in the women, there was a significant difference between the age groups (younger and older than the median age [median =74.1 years], respectively). The mean PGWB index indicates a high degree of subjective well-being in this group of Swedish seniors. Of the PGWB subdimensions, general health had the strongest positive relationship with physical activity (r (2)=5.4%). For the subdimensions of depressed mood, positive well-being, vitality, and PGWB index, physical activity had an r (2) ≤ 4%, while the contributions of sex, age, and biomarkers were minor. CONCLUSION We have estimated the contribution of physical activity to the variance of subjective well-being in active seniors. Physical activity appears to play a greater role as a determinant of subjective well-being than do biomarkers of somatic health, especially in females, but most of the variance remained unaccounted for by the studied variables.
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Affiliation(s)
- Lovisa A Olsson
- Department of Laboratory Medicine/Clinical Chemistry, Örebro University Hospital, Örebro, Sweden
- School of Health and Medical Science, Örebro University, Örebro, Sweden
| | | | - Torbjörn K Nilsson
- Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umeå, Sweden
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Christian LM, Iams J, Porter K, Leblebicioglu B. Self-rated health among pregnant women: associations with objective health indicators, psychological functioning, and serum inflammatory markers. Ann Behav Med 2014; 46:295-309. [PMID: 23765366 DOI: 10.1007/s12160-013-9521-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Biobehavioral correlates of self-rated health in pregnancy are largely unknown. PURPOSE The goals of this study were to examine, in pregnant women, associations of self-rated health with (1) demographics, objective health status, health behaviors, and psychological factors, and (2) serum inflammatory markers. METHODS In the second trimester of pregnancy, 101 women provided a blood sample, completed measures of psychosocial stress, health status, and health behaviors, and received a comprehensive periodontal examination. RESULTS The following independently predicted poorer self-rated health: (1) greater psychological stress, (2) greater objective health diagnoses, (3) higher body mass index, and (4) past smoking (versus never smoking). Poorer self-rated health was associated with higher serum interleukin-1β (p = 0.02) and marginally higher macrophage migration inhibitory factor (p = 0.06). These relationships were not fully accounted for by behavioral/psychological factors. CONCLUSIONS This study provides novel data regarding factors influencing subjective ratings of health and the association of self-rated health with serum inflammatory markers in pregnant women.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA,
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Shanahan L, Bauldry S, Freeman J, Bondy CL. Self-rated health and C-reactive protein in young adults. Brain Behav Immun 2014; 36:139-46. [PMID: 24513874 PMCID: PMC4313081 DOI: 10.1016/j.bbi.2013.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/17/2013] [Accepted: 10/20/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Poor self-rated health (SRH) and elevated inflammation and morbidity and mortality are robustly associated in middle- and older-aged adults. Less is known about SRH-elevated inflammation associations during young adulthood and whether these linkages differ by sex. METHODS Data came from the National Longitudinal Study of Adolescent Health. At Wave IV, young adults aged 24–34 reported their SRH, acute and chronic illnesses, and sociodemographic and psychological characteristics relevant to health. Trained fieldworkers assessed medication use, BMI, waist circumference, and also collected bloodspots from which high-sensitivity CRP (hs-CRP) was assayed. The sample size for the present analyses was N = 13,236. RESULTS Descriptive and bivariate analyses revealed a graded association between SRH and hs-CRP: Lower ratings of SRH were associated with a higher proportion of participants with hs-CRP >3 mg/L and higher mean levels of hs-CRP. Associations between SRH and hs-CRP remained significant when acute and chronic illnesses, medication use, and health behaviors were taken into account. When BMI was taken into account, the association between SRH and hs-CRP association fully attenuated in females; a small, but significant association between SRH and hs-CRP remained in males. CONCLUSION Poor SRH and elevated hs-CRP are associated in young adults, adjusting for other health status measures, medication use, and health behavior. In males, SRH provided information about elevated hs-CRP that was independent of BMI. In females, BMI may be a better surrogate indicator of global health and pro-inflammatory influences compared to SRH.
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Mayo NE, Scott SC, Bayley M, Cheung A, Garland J, Jutai J, Wood-Dauphinee S. Modeling health-related quality of life in people recovering from stroke. Qual Life Res 2013; 24:41-53. [DOI: 10.1007/s11136-013-0605-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 11/28/2022]
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ÅKERSTEDT T, LEKANDER M, PETERSÉN H, KECKLUND G, AXELSSON J. Sleep polysomnography and reported stress across 6 weeks. INDUSTRIAL HEALTH 2013; 52:36-42. [PMID: 24292880 PMCID: PMC4202771 DOI: 10.2486/indhealth.2013-0169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/29/2013] [Indexed: 06/02/2023]
Abstract
Despite the common notion that stress impairs sleep there is little published data showing that sleep (polysomnography (PSG)) is impaired across several sleep episodes in individuals who complain of daily stress during the same period. The present paper aimed at investigating such a connection. 33 subjects had 3 sleeps recorded with PSG at home across 6 weeks and kept a sleep/wake diary each day, including 3-hourly ratings of stress (scale 1-9). The stress ratings and the conventional PSG parameters were averaged across time. A stepwise multiple regression analysis showed that the best predictors of stress were Stage 1 sleep (beta = 0.49), latency to Stage 1 sleep (0.47) (adjusted for anxiety and age). Other sleep continuity variables had significant correlations with stress (reversed) but did not enter the multiple regression analysis. The correlation between stress before the start of the study and PSG data was not significant. It was concluded that moderately increased stress over a longer period of time is related to moderate signs of disturbed sleep during that period. This may be of importance when considering stress as a work environment problem.
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Affiliation(s)
| | - Mats LEKANDER
- Department of Clinical Neuroscience, Karolinska Institutet,
Sweden
| | | | | | - John AXELSSON
- Department of Clinical Neuroscience, Karolinska Institutet,
Sweden
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Lekander M, Andreasson AN, Kecklund G, Ekman R, Ingre M, Akerstedt T, Axelsson J. Subjective health perception in healthy young men changes in response to experimentally restricted sleep and subsequent recovery sleep. Brain Behav Immun 2013; 34:43-6. [PMID: 23820239 DOI: 10.1016/j.bbi.2013.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 06/17/2013] [Accepted: 06/25/2013] [Indexed: 01/06/2023] Open
Abstract
Sleep and subjective health are both prospectively related to objective indices of health and health care use. Here, we tested whether five days with restricted sleep and subsequent recovery days affect subjective health and is related to increased levels of circulating IL-6 and TNF-α and fatigue. Nine healthy men (23-28 ears) went through a 6-week sleep protocol with subjects as their own controls in a repeated measures design with a total of 11 nights in a sleep laboratory. The experimental part of the protocol included three baseline days (sleep 23-07 h), five days with sleep restriction (03-07 h) and three recovery days (23-07 h) in the sleep laboratory. Subjective health and fatigue was recorded daily. Eight blood samples were drawn each day (every third hour) on 8 days of the protocol and analyzed with respect to IL-6 and TNF-α. Subjective health deteriorated gradually during restricted sleep (p=.002) and returned to baseline levels after three days of recovery. IL-6 and TNF-α did not change significantly. Fatigue increased gradually during sleep restriction (p=.001), which significantly contributed to the association between restricted sleep and subjective health. The study is the first to show that subjective health is directly responsive to changes in sleep length and related to increased fatigue. Thus, subjective health is differently appraised after manipulation of one of its presumed determinants. Larger experimental studies would be beneficial to further distinguish causation from association regarding the underpinnings of subjective health.
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Affiliation(s)
- Mats Lekander
- Stress Research Institute, Stockholm University, Stockholm, Sweden; Osher Center for Integrative Medicine and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Siennicki-Lantz A, André-Petersson L, Elmståhl S. Decreasing blood pressure over time is the strongest predictor of depressive symptoms in octogenarian men. Am J Geriatr Psychiatry 2013; 21:863-71. [PMID: 23567417 DOI: 10.1016/j.jagp.2012.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 06/29/2011] [Accepted: 07/26/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the longitudinal impact of blood pressure variations and vascular risk factors on depressive symptoms in the elderly. DESIGN Longitudinal and cross-sectional cohort study. SETTING Urban population of elderly men, city of Malmö, Sweden. PARTICIPANTS A total of 809 randomly included men took part in a prospective cohort study, "Men born in 1914", and 171 survivors reached the age of 81 years. MEASUREMENTS Depressive symptoms were estimated at the age of 81 using the Zung Self-Rating Depression Scale (ZSDS). Vascular risk factors were identified at both 68 and 81 years of age. RESULTS At the age of 68, diagnosis of hypertension and on-going antihypertensive therapy were more frequent in subjects with high than low ZSDS scores. In contrast, at age 81, the highest ZSDS scores correlated with low systolic blood pressure (SBP). Declining SBP between the ages of 68 and 81 was more frequent in high-scoring than in low-scoring groups. Subjects with high ZSDS scores took more drugs and had more clinical diagnoses at age 81. Those taking hypnotics and sedatives had higher ZSDS scores, lower SBP at 81, and showed more frequent decrease in SBP during the observation period. CONCLUSION Depressive symptoms in octogenarian men could be predicted by hypertension earlier in life, and were strongly associated with decreasing SBP during the last decade.
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Affiliation(s)
- Arkadiusz Siennicki-Lantz
- Division of Geriatric Medicine, Department of Health Sciences, Skane University Hospital in Malmö, Lund University, Sweden.
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Gill JM, Saligan L, Lee H, Rotolo S, Szanton S. Women in recovery from PTSD have similar inflammation and quality of life as non-traumatized controls. J Psychosom Res 2013; 74:301-6. [PMID: 23497831 DOI: 10.1016/j.jpsychores.2012.10.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/03/2012] [Accepted: 10/29/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is associated with greater concentrations of inflammatory biomarkers as well as substantial medical burden; however, it is not clear if these morbidity risks change following recovery from PTSD. In this study we compare women who have recovered from PTSD, to those with current PTSD, and healthy controls on their perceived health and inflammatory and metabolic biomarkers. METHODS We studied 3 groups of women: those with current PTSD, those who reported recovery from PTSD, and healthy non-traumatized controls, which were determined using standard diagnostic instruments. We obtained a morning blood sample and examined concentrations of inflammatory biomarkers of: interleukin 6 (IL-6) and c-reactive protein (CRP), and lipid concentrations. Lastly, we evaluated health related quality of life (HRQOL). RESULTS Women who had recovered from PTSD had a similar HRQOL and inflammatory biomarkers as non-traumatized controls. Their concentrations of inflammatory biomarkers were lower than women with current PTSD, and similar to non-traumatized controls. CONCLUSION Health perception as well as biological indicators of health significantly differ in women in recovery from PTSD, compared to those who remain symptomatic. These findings suggest that the psychological recovery is associated with normal levels of inflammatory biomarkers and HRQOL.
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Affiliation(s)
- Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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Harpsøe MC, Jørgensen KT, Frisch M, Jess T. Risk of inflammatory bowel disease according to self-rated health, pregnancy course, and pregnancy complications: a study within the Danish National Birth Cohort. PLoS One 2013; 8:e59698. [PMID: 23527254 PMCID: PMC3602009 DOI: 10.1371/journal.pone.0059698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/17/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Poor self-rated health (SRH) has been connected to immunological changes, and pregnancy complications have been suggested in the etiology of autoimmune diseases including inflammatory bowel disease (IBD). We evaluated the impact of self-rated pre-pregnancy health and pregnancy course, hyperemesis, gestational hypertension, and preeclampsia on risk of IBD. METHODS Information was collected by questionnaires from The Danish National Birth Cohort (enrolment 1996-2002) at 16(th) and 30(th) week of pregnancy and 6 months postpartum. A total of 55,699 women were followed from childbirth until development of IBD (using validated National Hospital Discharge Register diagnoses), emigration, death, or end of follow-up, 31(st) of October, 2011. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards models adjusting for age and evaluating pre-pregnancy BMI, parity, alcohol and tobacco consumption, and socio-occupational status as potential confounders. RESULTS Risk of IBD increased with decreasing level of self-rated pre-pregnancy health (p = 0.002) and was elevated in women with poor self-rated pregnancy course (HR, 1.61, 95% CI 1.22-2.12). Associations persisted for more than 5 years postpartum. Hyperemesis and preeclampsia were not significantly associated with risk of IBD. CONCLUSIONS This is the first prospective observational study to suggest that poor self-rated health--in general and in relation to pregnancy--is associated with increased risk of IBD even in the long term though results needs further confirmation. Symptoms of specific pregnancy complications were, on the other hand, not significantly associated with risk of IBD.
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Affiliation(s)
- Maria C Harpsøe
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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Todorova IL, Tucker KL, Jimenez MP, Lincoln AK, Arevalo S, Falcón LM. Determinants of self-rated health and the role of acculturation: implications for health inequalities. ETHNICITY & HEALTH 2013; 18:563-585. [PMID: 23425383 PMCID: PMC3758374 DOI: 10.1080/13557858.2013.771147] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Self-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined. DESIGN The paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects. RESULTS The strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population.
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Affiliation(s)
- Irina L.G. Todorova
- Northeastern University, Center for Population Health and Health Disparities, 360 Huntington Avenue, Boston, MA 02115, US
| | - Katherine L. Tucker
- Northeastern University, Center for Population Health and Health Disparities, 360 Huntington Avenue, Boston, MA 02115, US
| | - Marcia Pescador Jimenez
- Northeastern University, Center for Population Health and Health Disparities, 360 Huntington Avenue, Boston, MA 02115, US
| | - Alisa K. Lincoln
- Northeastern University, Center for Population Health and Health Disparities, 360 Huntington Avenue, Boston, MA 02115, US
| | - Sandra Arevalo
- Northeastern University, Center for Population Health and Health Disparities, 360 Huntington Avenue, Boston, MA 02115, US
| | - Luis M. Falcón
- Corresponding author: Luis M. Falcón, College of Fine Arts, Humanities, & Social Sciences, University of Massachusetts at Lowell, 150 Wilder Street, Lowell, MA 01854-3082, 978-934-3843,
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